Webinar - An Easy Way to Reimagine Peer Review

Peer Review 2.0 at Cherokee Regional Medical Center

  • 00:10:11 - 05:10:11


    Nestor Carrillo  01:35

    Nestor Carrillo 00:09

    Thank you everyone for joining us today for an easy way to reimagine peer review. Today we have two fantastic presenters, we're joined by Jerrod Bailey, CEO of Medplace, and Terri Shermer, and RN, former risk leader at Cherokee Regional Medical Center. A little bit about Jerrod, he can give some more background into his experience, but 20 years of experience in venture backed technology, he's an expert operator in healthcare technology development and human centered design. A quick note for you guys, if you can take a look at this slide here, we will be doing some polling at the end of the presentation. To access the poll, you can either go to menti.com, and enter the code there. Or you can scan the QR code with your phone. And that'll take you straight to the to the page where you would sign up for the polling a couple. It's four quick questions. And we'd really appreciate if you could participate again, either go to menzi.com and enter that code or scan the QR code there. And on that note, I will turn it over to Jerrod.


    Jerrod Bailey 03:00

    Great. Thanks, Nestor. Everybody, I'm Jerrod Bailey. I am the CEO of this company called Medplace. I think everybody got here through an invitation. From constellation. There's a bit of a backstory I think there that's interesting as well. But I'm also joined by by Terri shimmer today, hey, Terri. She might be a mute. But I will give you a little bit better introduction here a little bit later. What we're going to talk about today is peer review, how it relates to risk. And in in opportunities with peer review that are available now that I think you guys will find really interesting and in rather than me telling you how interesting it is, I thought it'd be great to have one of your peers on and that's really working with Terri for the last year on Cherokees peer review process. And one of the things they say is there's really nothing, there's few systems like peer review that are more capable of enhancing delivery of care by making very small incremental changes to it. And if I told you, if you change your peer review process by about 1%, you'd probably double the efficacy of it. That's what we're going to go into today. So let's kind of unpack peer review really quick, just to kind of lay the foundation and then I'm going to start to paint a little bit of a vision of what that might look like a 2.0 process might look like and Terri's going to give you some actual boots on the ground experience with this 2.0 type of approach. So with that, Nestor if you could take me to the next slide. So it's interesting. I come from a technology background. I've done a lot in healthcare and other spaces that come from a human centered design background and that means less technology, more humans, really designing technology around the people First that need it. And then and then you can into the technology after that process. But it's important when you look at something like peer review, which is involving a lot of humans and a lot of people with, with experience and you know, a lot of teams that have team dynamics and things like that. So peer review is this really interesting, important process, that that is carried out by humans, right. And there's actually an opportunity for technology to come in the middle of that. And I'll kind of show you what that looks like. But what are stakeholders saying about peer review? So it's important, but what does everybody saying about it? So Nestor, let's go to the next one. We Medplace work with doctors all around the country, we have about 650 doctors on our platform, from every specialty you've ever heard of. They're all around the country. They're in big hospitals, little hospitals, clinics, they've got usually 10 years or more of experience. And they're very, very talented people. They're people just like the physicians that you're working with every day. And we pulled them because we were we were looking initially at how do we how do we facilitate or come up with solutions for the peer review world. And it was really not great feedback, I guess a lot of doctors will recognize that their peer review process is important. But when you really ask them without any microphones on or them having to answer this question to their team, a lot of doctors feel like the process is not as effective as is, I think we're all hoping that it would be in a lot of times, you get words like political and bias and things like that put into the process. Sometimes it's weaponized against them. Often it's a reactive process, because you know, it only happens when things go badly. And of course, that's a natural place for peer review to come in. But you know, it peer review, that's, that's done more proactively, we found when just working with hospital clients, it's a very different mentality becomes less punitive and more about quality of care and about increasing the the system's the quality delivery, as time goes on. So next slide, if you would Nestor. The carriers, so the medical malpractice insurance carriers, it's important to them this, this quote came from a from a, somebody who's a risk manager at a top five carrier. And she said, when it gets to us, we're already down the line and bad things have happened. I'd like to see our hospitals doing independent reviews earlier. And independent reviews is really the key. And that's we're going to dig in here. independent reviews are hard to do. If you've ever tried to do one outside of your employee physician group, every one of us if you've tried to do that it's probably been ghosted, as we say by by a well meaning specialist working at some other hospital. So how do you make that work? And how do you do it at scale is really important. But it's important to the carriers because they're at the downstream risk level, right, they'd love to see more independent reviews done earlier. And that's a little bit of the backstory. And I'll segue here a little bit. The reason one of the reasons that you heard from constellation is constellation actually started developing this idea of Medplace a few years ago, they really care about their physicians. And when something bad happens, even if it's not a claim, or a lawsuit, they really wanted to be able to come in quickly and early, and be able to come along alongside their insured doctors and be able to, uh, give them independent reviews fast, something that would assuage their fears, and really establish for them the facts of the case and things like that, so that they could continue to practice medicine and not have the burden over them. So they do a lot of early resolution and things like that, well, that necessitated them to use some technology because it was taking months to get a review done. And they want to do it in a matter of days at most, a couple of weeks. So that's actually where some of the genesis of med police came from that we've worked with other carriers and hospitals since then to develop what we've got today. But I want to let you know that you know, there's really a lot of empathy and heart behind why Medplace even exists. But as as we matured as a company and as we've been doing these reviews at the carrier level, it became obvious that we could push further into the hospital systems themselves and be able to make something that has become very easy for the carrier be able to bring something like that to to the hospital level. And Terri will give you some idea of what that feels like. Next slide. So administrators, what are they saying? Well, 25% of administrators can't recall basic peer review metrics. It's very common that you know, peer reviews have become the sort of road thing don't necessarily know what's coming out of it. We're not necessarily happy with it. Data and even trusting of the data that's coming out of our peer review process, because of some of the system design flaws in it, and we'll address those here in a second. And then only a third actually truck track process of care improvement, right? You know, peer review is really about and should be about improving the delivery of care, but often, it doesn't get that far. Often. It's not serving that function. So next slide. In yet, and this is from PubMed, peer review accounts for 18% of the variation of quality and patient safety, that's a massive number, there's, there's not a lot of things that have that, that type of effect on patient safety and quality. So here's this like, really important system. And we're all we all have to do it because Joint Commission, other say we have to do it. We're all involved in it. And yet, there's there's some components that if we can just tweak those a little bit, and all of a sudden, we can unlock a lot of the opportunity with peer review. Next slide. So peer review today. This is from an article on the left side here, peer review of physician and clinical practice has existed essentially the same form for more than 100 years. That is, in fact, true. I think we've all seen it. We've all been passed down a process that was started years before us can continue that process today. But we'll find that oftentimes, and this is not always the case with every hospital, that oftentimes it's rigid and prescriptive, we oftentimes complain that it's reactive and punitive. We, we acknowledge often that there's cognitive and professional bias involved with it. There's also some unfairness that can be exposed and that can be exposed through litigation and things like that. And, and more than anything else, I think we've all been through it, it's it can be slow, and mostly because it's under resourced. And it's just resource intensive to do peer reviews in general. And then you start talking about independent peer reviews and going outside the physician group. And it's just it just goes off the rails, right? It's there's a lot of moving parts, and not enough, not enough people to keep it going. Next slide. So why does it matter? Well, peer review underpins our entire delivery of care, bad data hides risk. So we're doing things today in clinical practice, that are risky behaviors, but we don't necessarily know about it, because it's not being exposed to a peer review process. And that just means that we are we're building up harm events in in risk events that are going to come later, maybe years later, when we could be figuring things out now, and really improving quality of care. Reactivity never really gets to real improvements, right? It usually is just ends up being stopped gaps. If it's called unfair, we might find out that we've got one, we may have legal action but but even before legal action, we find that we've got doctors that are not happy, they're being reviewed by people that they don't consider fears. They're being reviewed by partners or competitors, things like that. And this idea of this, this doesn't feel fair is an important one for us to address, I think an easy one for us to address. And, and then if it feels punitive, unfair, then the less things get reported, right. So these are all things that I hope we can address. Some of the med plays can address some of it, we address through our philosophy, how we operate as a hospital or as a clinic is important to that. So next slide. So resource constraints, right? So everybody's stretched thin. It's been particularly bad the last couple of years. We asked our doctors to do peer reviews, but it's not compensated work. So it's kind of like it ends up being the thing, the last thing on their plate they do, they may not necessarily pour over it the way that's they might if they were doing something else, they were being compensated for it. That's the reality of what we're dealing with. Right. And we all buy into the process and everyone expects doctors to peer review each other and that's normal. And that's right, that'll continue limit limited access to the right sub specialties. You know, yeah, I've got a great OB Gen, but I don't have to, and when I need to peer review, my OB Gen I don't really have a lot of good options to do that. Right. So where do I find these specialties if I if I need to? And then usually we have one one man or one woman army is kind of running all of this stuff on top of a lot of other duties and Terri's is one of those one person armies, but many of you are as well too, right? So it becomes very, very difficult to manage a lot of these moving parts and to to get over some of these constraints. Next slide. We talked about the legal exposure of this. That's another thing that we want to Be able to avoid, right? We want to be able to do things in a way that is defensible, if you know if it leads to actions that we're taking, right. So we want to be able to do things that that show very unbiased approach. It's like carriers do independent reviews all the time when they do things like claims, is because they want to be able to show further down the line that they removed bias and things like that, and they did these things properly. Next slide. I talked about bias. So there's kind of two kinds of bias, especially with peer review. There's the bias that we always bring in, right cognitive bias, we bring in hindsight bias, right? Oh, now that I know the outcome, I judge the the care that was delivered, right was really easy things to do. We do them naturally as humans. But they if you're, if you're on the other end of that, you're the doctor that's being reviewed, and you're recognizing that there's a lot of armchair quarterback type of stuff going on, it can be very difficult, right? It's going to be a natural part of every peer review process, even independent peer review process, but we can account for that. And we can, if we if we are accounting for it, we can help prepare the reviewer to, to really try to look a little bit more independently outside of these lenses. Now there's another kind of bias as well. And that's the next slide. And that's the social biases, right? So we're in the same workgroup, or we're competitors, right, we have to show up in and work with each other every day, right? There's just an inherent when I talked about system flaws, there's some inherent system flaw in that because I care about who my relationship with the people that I work with every day doesn't mean that I'm going to throw them under the bus during a peer review. But it means that I'm always sort of consciously or subconsciously checking what I'm saying. And there's big personalities in what we do. And there's all sorts of other stuff. And knowing that going into a peer review, it's going to paint how how much critical feedback, I'm actually able to do within that, right. So it's a bias that we want to we want to try to mitigate. We also get into groupthink, right? Or we've, we've always done it this way at our hospital. And that's, that's what we know. And it was it was established a long time ago. And I don't know why. But I do it today. Right? So there's so there's, there's kind of all of that that we're dealing with, right. And if we don't create the opportunity for new ideas to get injected into that, then we sort of miss all of those opportunities, right? So we want to account for that. And then whether consciously or unconsciously, many of us often are, are displaying bias, whether it relates to race, or, or sex, or sexual orientation, those are just things that come with being human sometimes. And we're all on a spectrum of awareness of that. So the question is, is how much is that playing into what's going on here? When we're doing our peer reviews, next slide. And then limited, right or reactive, right? So the reviews might be limited, they're based on bad outcomes. And where I've seen hospitals that actually are so proactive, that they just automatically look at procedures that were done, they take a percentage of everything that's done, they do a percentage of those internally, they do a percentage of them externally. And it's really a proactive process. And what that does is it avoids the whole getting lucky thing where it's like, hey, nothing bad has happened. So we'd never review this, either this position or this procedure, whatever. And really, we're just getting lucky, right? There may be a bad practice, it's been going on even maybe even for years. So we just kind of got lucky because nothing bad has actually been reported yet, right? And but if we create a system that's easy to use, it creates the ability opens up the opportunity to start being more proactive, and start actually seeing some of those patterns before they become issues. And then ultimately we're reactive because we're resource constrained. So oftentimes, when something bad happened, we want to get an independent peer review done. Six, nine months later, we're actually getting it done. That's way too long, right? It's for too long for the provider involves too long for everybody. So you know, we want to be able to try to design systems that make it really, really fast to do that, like how, how can we get reviews done and get get eyes on some of these things independently, within a few days, instead of months. Next slide. So, I wanted to sort of paint a picture for everybody of a peer review 2.0 process, and it's really simple. It's taking 1% of our reviews, and it's figuring out how it's implementing those independently. And we'll talk about the power of that. But it really can transition us from being rigid, to being flexible, right from being reactive and preventative to to proactive and improvement focused right It can get us from from where we're at today, which may be a lot of bias into a place where that's really not even an element anymore or it's it's mitigated substantially, right. protect ourselves be able to create a proper defensible process for for when we get reviews done, and ultimately make it easy. Right? Let the army of one you know those are ins of you are out there managing your your risk, or those of you who are managing your the medical committee in staffing, be able to say, Oh, this, this actually can be the easiest thing I do all day, not the hardest thing that I do all day. Next slide. So, we're going to talk, we talked about what's getting in the way, what I thought we would do, actually, let's jump to the next slide. Yeah, so what if it was easier? Let me paint you guys a picture. And I'm going to do it with my friend Terri, who's joined us. Can you jump forward Nestor? One more. So I think we've kind of covered all this stuff. Yeah, we're going to talk about a new approach. I'm gonna give you guys a vision for what independent reviews could look like. And the person that's gonna help me is Terri. Hey, Terri, are you with me? No, we were having some audio issues earlier. But if you're talking, I can't hear you. Give Terri a second. She might need to dial in. She's got some. I think you can share your screen Gjerde. Okay, good. So yeah, while Terri's getting on, I am going to show you guys what this looks like. So let me get my screen ready. And then I'm going to start sharing. Right, it's, I'm ready to go faster if you could tell me when you can see my screen. Yep, I can see that. You got it. Okay, great. So imagine that you need to get a review done. And you want to do this independently, right. So you need to, you need to find a radiologist to look at your to develop to do a peer review, this might be just an opp might be an FTP review might be more in depth that might be you know, just, you know your for your annual cycle, you need to make sure that your peer reviewing somebody but let's, let's see what a new process could look like. So imagine you log in somewhere. And you've got a few reviews that you're doing externally. And you can see all of them on a nice little dashboard. And you can, you can see where you have to react to something where you're just waiting. But let's create a new request. So maybe this is something more serious, there's a mortality review. And I'm going to enter some information. Why am I requesting it? You know, what's been happened when it happened? What kind of specialty Am I looking for? Right? So pick your specialty could be hundreds. And a little bit more information on what I'm requesting. And then I am going to upload a bunch of records. I'm going to upload some PDF output from my EMR system, I might upload some radiology imaging, I don't have to send it to send CDs or papers and artifacts, anything anywhere. Just real simple. I just put everything up into this website. And and then what I say is I'd like to match with an expert. And instead of me going out and spending the next few weeks or months looking for a doctor that's willing to spend the time to help. By the next morning, I get a little alert that says you've have some CVS to review. And I come in here and I can start looking at some of these individuals that are really ready to help me right and I can see that they've been rated and that's all really really convenient. I decided that I really and by the way, I may share those CVs with my medical committee and say hey Dr. Evelyn's available, and we can move forward with her. And if I pick her you guys have ever driven in an Uber, Dr. Evelyn a lot like an Uber driver, except she's not sitting in a car. She's probably sitting in an or somewhere or she's she's in clinic, she gets a little ping on her phone and it says you've been asked to review this case. And she gets to see the basic information. And she gets decided, if she's available. She can accept it. And if she does, then she can start doing her work sort of ready to go. She may have a question that she needs clarification on and maybe there's a missing file or a missing record that she thinks would be important. Maybe I want to talk to her and I can, I can actually schedule a time to discuss with her. But in the meantime, she's busy working on the report that I need her to fill out. I decided, Hey, guy, let's have a call. And maybe I invite my entire medical committee to this call, maybe I want to invite other folks, maybe it's just gonna be her and I, and we'll talk through it. And we'll both get calendar invites with teams or a zoom link on it. And we'll chat and we'll chat through the case. Right. And, and maybe she can, she's delivered a report before then maybe she delivers it after because I want to talk to her first, but it's really flexible, we have a nice conversation, she gives me the real clinical perspective, right? She's 10 years or more practicing. She's very knowledgeable in in her specialty. And she's clinical. So she's really she's she's doing this every day. And we have a really such a substantive conversation. And, and she gives me a really good feedback, not just a rubber stamp feedback, but here's here's her thoughts and her ideas. And when we're all done, I come back in here. And they review what she said? And I say, Okay, this has been great. And I come back into this website. I download my report. And then I rate her just like your rate, your Uber driver fee, you know what she was amazing. Very, very helpful. And, and I click Submit, the things I didn't have to do is I didn't have to get a contract with her, I didn't have to get an invoice from her. I didn't have to work out payment with her. I didn't have to do any of that stuff. It's all automatically done. I just got straight to what I needed, which was a qualified physician, looking at my case with me. So that's just a glimpse of what med plates does. And that's what we brought Terri, here to talk about, because Terri is sitting in a lot of your chairs right now, too. But Terri, what can you give us a little bit of your background? Are you with me? First of all?


    Terri Schimmer 27:09

    I think so. Can you hear me? I sure can. Okay, good. Yay. Sorry about that. Yeah, I, my name is Terri shimmer, as Jerrod said, I am an RN that has worked at a critical access hospital my entire career. We're located in Cherokee, Iowa populations a little under 5000. But small facility, we had five family practice physicians and five er providers on staff and I most recently worked as a patient advocate and risk manager but was charged with overseeing peer review, probably for the last couple years and found it to be a struggle for us. We were affiliated somewhat with Unity Point in Sioux City, Iowa larger facility that was, had always given us some support with peer review. But our go to position that we often used was given different job duties. And so it got to the point where it was just really difficult to even tracking down and get a response. And let alone do a review for it. So we kind of relied heavily on internal review. But again, with being a small facility, we just struggled with really good information, because these guys and women work with each other every day eat lunch together. And so it was really hard to peer review each other. And so they just tended to be really soft. Reviews, it wouldn't be uncommon for me to get one with just no concerns. Was the the report that I would get. And it just I guess we just needed more. And certainly when we had our facility survey, that was not the last thing that surveyors talked to us about was how do you know that you have quality positions when you go to credential and when you go to renew their contracts? Excuse me. And so we got through the survey, but we knew we had to do something different. And we just needed to do better. And so that's when we were recommended Medplace and we took that route and worked with them this year on peer review, and I guess I can support everything Jerrod has said because it's it is exactly how he has presented it to you. It's been very easy to request a review. It's been very easy to just upload the documents you know, put in the request. Send them the documents Choosing the provider that was going to do the review was, was really great and easy to do as well. And then I actually use the same provider if it was like a hospitalist I was able to use him again and again for our facility,


    Jerrod Bailey 30:20

    because we have some continuity there. Yeah,


    Terri Schimmer 30:22

    yes, exactly, we did the same thing, I think with an ER, review that we use that reviewer again. So that part was really great. But I guess the big thing was just how quickly the turnaround was like Jarrett said, maybe a week, or sometimes maybe a few more days, they maybe just send you a chat that they need an additional report, you just upload it, send it back. But the reviews themselves are just so rich and so detailed, that they really gave a whole new input for that provider, we actually had three new physicians in the past year, that are just started their practice. And so I think we really owe it to them to give them good quality feedback as Jerry said, you don't want to wait till something's gone wrong. And, and then hit him up the back of the head and kind of say, well look at here but we've done some quality reviews, just reviewing like a sepsis case, or that kind of thing, just for just the quality of the care that they gave some of the things in the review, besides just did they meet the standards of care, what you know, was their medication choices, correct, I would have done this, or you could have thought about this. But they also talked about documentation by the provider, which I thought was really a good thing to talk about, because I think we all know, some of our providers are very detailed, have excellent documentation, and some aren't so good. But they basically would say to them if this chart would ever get challenged they encourage better documentation in certain areas. And so just lots of good information. And the fact that it was from an unbiased eye, outside of our facility, I think was really valuable. I mean, that can get kind of defensive about all of this. But I think they got better as we went along. And we actually had some that were recommended to go to peer review committee, which we hadn't had that for a long time, because I began, I think when you're working beside somebody, you don't want to make that recommendation. But we've had, we've had a few of those, and, and they were excellent, that was all of our medical staff is part of that committee, and just good discussion. And I think in the end better care, I think everybody takes some something away from those meetings. And ultimately, that's what we wanted.


    Jerrod Bailey 33:06

    Sorry, that's something, the better care, it's something that that you, it's starts with the leadership at Cherokee, the CEO, and it's us really have a philosophy for better care. And you really seem to be really intentional about what that means, right? And even if it means doing hard things, you seem really intentional about that philosophy.


    Terri Schimmer 33:29

    Right, right. Our CEO, I mean, quality, quality is just a high priority for him. And, and I would say probably, historically, we probably haven't spent a lot of money on peer review. And again, like you say, some of the things that we did externally, we didn't get our reports, like for four or five months, I think one facility never even billed us because it took so long to you know, to get given the information back. And I think they must have just said, Well, we're gonna give you a freebie. Very good. But we definitely, we committed a fair amount of more more money in the budget for external peer review. And as far as I'm concerned, it's been well worth it.


    Jerrod Bailey 34:19

    That's great. You know, you we talked about this when whenever a position is being reviewed, right, in any environment, that can be a little bit contentious, awkward, something like that. How did how did your you mentioned a little bit of this already, but how did the doctor sort of react to some of the information coming out of these reviews? What was that like?


    Terri Schimmer 34:42

    Well, I think you mentioned that it's kind of uncomfortable for them, I think when they know that their care is being reviewed, and even if it's internal. There's a little bit of a discomfort to it, but I just feel like it's been better since we We've been doing the external reviews. And and the information is, is just really, really good in the the reviews that we've got. And I think the way that they have stated things that could be done differently was tactful. And then I just think a lot of how they put it did not make them feel like they were being punished or for I mean, I think it was just truly from a standpoint of you might want to think about this, or I might have done this and consider that. And so I think that helps a lot with the defensiveness. And and I think the peer review committees that we the meetings we had, they, they were really good, they all talk together, they basically, and even the physician that maybe the concern was with when they actually came to the table for the committee, they had done some good thinking on what they should have done differently. And so I mean, I think they, I don't know, I felt like there was a, it just kind of grew to be a much better attitude about it. I think they understood the reasoning we're doing it, and that its quality and the patient, what's best in the long run. And that was our goal. And I think they proved to understand that I guess,


    Jerrod Bailey 36:26

    yeah, did it did it help? Because I assume you did this, sharing the credentials, and the backgrounds of the people doing the reviewing, did it help, when they saw who had reviewed them? And in sort of their background, and you know, that they should, their specialty, and things like that? Was that? Was that also helpful in mitigating factor?


    Terri Schimmer 36:47

    Yeah, I think so. And I even when, I mean, I was the one that chose them on the front end, but I usually tried to kind of look at their resumes and, and as far as what their backgrounds were, and maybe even where they had interned at or whatever it might have been if it was maybe similar to, to us in some, some respect. So you kind of tried to match that Oh, a little bit. But I think also the fact that we use the same, same reviewer, they got to know that name and so I don't know, I think, I don't know, it just definitely was more accepting to them. You know, as we went along because it was just external review, unbiased, just looking at the care, and providing their input. And it just, I think, really, overall, has has gone very well, that's our dogs.


    Jerrod Bailey 37:44

    Amazing. Well, I love to hear that. And these, these doctors don't introduce themselves doctors, they've been in the same shoes, they are in the same shoes as your, your doctors. And one of the I told you this early on with Medplace our we have two Defining Principles. And the first is empathy. Right. So if ever, if you build empathy into the process, you you inevitably get better outcomes. Well, this was great, Terri, amazing to hear the story. Thank you for you know, for kind of walking us through that. I do want to open it up for questions. See if anybody's got any questions, right, you can enter them into the chat I assume Nestor? Or are we are we a small enough group that you want to turn it on? How do you want to run it from here? And so because I know we also have some of the polling questions as well to tee up again.


    Nestor Carrillo 38:39

    Yeah, we can drop the questions into the chat. For the time being, I can give access to anyone that wants to ask the question, just raise your hand in the when you highlight over your own name. And then we can go ahead and give you access. So either way, if you want to open up the mic, just raise your hand and I can do that or you can drop it into the chat.


    Jerrod Bailey 39:03

    Perfect. While we're waiting for some questions to come in, if there are any at all. Can you do you want to open up the polling QR code again?


    Nestor Carrillo 39:14

    Yep, let me pull that up right now and then.


    Jerrod Bailey 39:21

    Right. So if y'all haven't done this before, hopefully, if you've ever used a QR code, usually just open up your camera app and kind of hovered over that thing. And it'll, it'll open up a little URL, and it'll take you to the questions. But if you're not that fancy, you can just go to minty.com. And you can punch in that little code there. And that will take you to the same place. So we'll leave that up for a second. Also, like some of you answer some of those questions. See how many of you are brave, brave enough? Don't worry, it's anonymous.


    Nestor Carrillo 39:51

    Yeah. So we'll give you a few seconds here. We'll move on to the next screen in a bit and then you'll We'll start, you'll start seeing the ability to answer each question one by one as we go through them. All right, let's go through to the next. Give me a few seconds here to file in. And let's go ahead and go to this first question. What department handles peer review at your organization? And we put a couple of options there. Feel free to drop any other answers into the chat?


    Jerrod Bailey 40:54

    Yeah, that's looking like a pretty expected distribution.


    Nestor Carrillo 41:06

    Let's go on to the next question.


    Jerrod Bailey 41:10

    I would say that's one thing about peer review is often it doesn't have an owner or an explicit owner. And I think that's why you see, you see, it gets left behind sometimes.


    Terri Schimmer 41:22

    Or it gets passed around a lot.


    Jerrod Bailey 41:24

    Yeah. Well, that's I mean, that's part of your story. Didn't you inherit it? Terri from?


    Terri Schimmer 41:29

    I did, and I think it had been around the horn to quite a few people before that. So yeah. Yeah.


    Nestor Carrillo 41:38

    Kara mentioned in for question, one that the quality team at her organization does peer reviews with the help of medical staff services. So that's also very interesting. Yeah, yeah.


    Jerrod Bailey 41:52

    Yeah. So needs improvement, an average very, I think, very typical responses. Right. So I think we all wish it could be a little bit better. I have to tell you, I I talked to a lot of hospitals about their peer review process. And most of them are average or low does how they would self self report. There was one hospital, I won't mention them, we've all heard of them. That is just amazing. They, they purposefully and always do like a very large percentage of their reviews externally. They're very proactive. It's extremely real. Well, Ron, and the physicians involved are very, very, it's not a punitive process at all. In fact, it's almost a cultural process to see how can we identify, you get points for identifying where you can improve things, right. And anyway, it's just really, really amazing. And I would, I would consider them in the top 1% of programs out there. But it's, it's really, really exciting to see something like that. But most most of us aren't in a situation where we would say that we're at that kind of level.


    Terri Schimmer 42:56

    I would support what you say there, though, Jerrod about it's a cultural thing. You know, that if you can get your providers to feel that and think that it shouldn't feel bad to them at all. Yeah, yeah, that's right. really meant to support them


    Jerrod Bailey 43:13

    yeah, it should be energizing, they should feel like they're there. And you know, I'll tell you this, if you want your doctors to be better doctors, have them review other hospitals have them participate if you if you have doctors that want to participate on our network and review others. There is there's nothing more fascinating watching a doctor who's who's actually being you reviewing for somebody else, and in like, in a really substantive, meaningful way, it's really, and they'll always come out of that and say, I'm a better a better doctor for having done these reviews. So if you, if you could change one thing about your peer review process, what would it be? No answers yet. I'm on pins and needles.


    Terri Schimmer 44:06

    One thing that I would share real quickly to Jerrod is the weekly touch points that we did with your team. What when we started because it was very supportive. I mean, it wasn't like you just signed up for it. And then the way you went and try to power through it by yourself. You know, we met weekly with three to four people on the team and talked about how it was going and you know, they gave me some input about what I was sending for information. That was great.


    Jerrod Bailey 44:42

    Yeah I get asked God or technology person, what do you have so many people involved in and I tell people like, technology does not replace people. It only it only should sort of get out of the way get things out of the way so that people can can do their work. But yeah when you're dealing with Something like peer review and in going through a new process for the first time having a friendly human and and people with clinical backgrounds on the other end that have been have done the same, the same job and they've been at Risk Manager and there are ends like that's really important in the whole process. Yep. Okay, we got some we have some good answers here. Let's see, let me read a couple. So things that you would change cultural communication change, have every physician not only aware that reviews are occurring, but openly inviting the reviews? Yes, that's that cultural change that we talked about? Higher quality review from internal physicians. Right. Exactly what you were saying, Terri, you get these sort of rubber stamp reviews that aren't helpful. Providers not afraid to give honest review of their peer. Yeah, I think that's, but that's the that's the part that I think when we talk about system design, it's it's an inherent system flaw if we're asking humans to betray their social selves, right? If this is my, like you said, I have breakfast with this person every morning. And to ask me to, to engage in a system that that requires me socially, to put myself at risk. Like that's just a hard system design. And to get over standardization, in reviewing cases proactively before issues events arise. So this is huge, right? So creating standards, so everybody kind of knows the rules in the rails have been laid in so that when you do these reviews everyone kind of knows what what goes in and what comes out. Right is consistent, like the rules are fair that the amount of reviewing that's being done is fair, right? Like, that's such a huge part of creating a process that, that physicians can then get behind. Right, and that they can buy into is not punitive, but proactive.



    Right, right.


    Jerrod Bailey 46:55

    Here's the next one having enough our staff to do the job. easiest ways to redirect charge rate, so just having enough people to do everything? Providers,


    Terri Schimmer 47:08

    this this date time, though, I mean, it really you mentioned that trying to find somebody that can do the review and making those calls and calling them back again, and how much are they going to charge? And there's a lot of time that just goes into trying to get one review done. And this, this was just just so slick. You know, it really was


    Jerrod Bailey 47:33

    I say we build the we've built the Uber for physicians. Yeah, I think doctors aren't driving people around. But we're, but Uber is interesting, right? It's a lot of really hardcore technology that's presented to us in a really simple way. It demystifies the process, right, I can see my driver approaching and things like that once you create something like that, it becomes much easier to decide, hey, I'm gonna get around versus drive somewhere. Providers provider's not finding review process as punitive or negative. Right. Any other advice there on that one? Terri, as far as like, because I know, we're all in a journey of getting to that point. But I need advice. Well, I,


    Terri Schimmer 48:16

    I think, I think that will come. You know I had one provider that we told them that we were doing this and that we had an external review company. And so we felt like we told them we'd be doing this, well, then we did a quality review on a hospital state for one of our providers, and he got a little bit sensitive about it and defensive, and you should have told me you were done. And I said calm down, sit down, let's talk. You know, and I mean, he has some recommendations on his documentation, especially and I said, they haven't sent you to committee, but just take what they've told you. And then pretty soon, he was like I do need to do better with my he finally kind of was like, okay, yeah, they're probably right. And so I think that you kind of got to work with them a little bit that I think we just were slowly seeing a better feeling about the whole process.


    Jerrod Bailey 49:21

    That's amazing, though, willing to go through and that's a cultural, that's a decision that comes from the leadership there as you're willing to go through hard conversations to get to better quality, right. And that's, that is so essential. And I love that. Let's see, Cara said helping providers understand and embrace peer review. There are several non standard practices that we use, and we attend webinars and conferences to learn peer review, but it's not our quote our process. So we give them the information on how to improve the process and make sure we have non biased reviews. And the information provided is not taken into account, right. So it's falling on deaf ears and the way that it's being delivered. And of course, you said and all So everything that everyone else was saying, it sounds to me, like maybe having those substantive conversations with the reviewer who is an expert in that specialty and can have those, those conversations like You're like you're used to having now Terri, where they're just very productive, right? And


    Terri Schimmer 50:19

    right. Yeah, yes. Well, and I would say, our most senior physician at our facility, he could probably work for you, he does excellent review of cases. And he actually was very good at supporting all of this as well. So sometimes if we did have a defensive provider, or that they just were not taking it real well he, he was more than willing to, and he he's a calm guy. So he often was a good voice of reason. So if you even could get one provider that just kind of a champion for it. That helps tremendously, too.


    Jerrod Bailey 51:02

    That's great advice. And I expect to CD in my Inbox by this afternoon, as we always need to doctors.


    Terri Schimmer 51:10

    Yeah, yes, that's true.


    Jerrod Bailey 51:14

    We have more questions. Is this last question? No, sir. Yes, I believe so. Okay, how many of you have done an external peer review? If so, how many? This is probably what, like, per year? Is that? Is that the timeframe? We should say? How many of these do you do per year externally?


    Nestor Carrillo 51:33

    Yeah, I think that's fair.


    Jerrod Bailey 51:35

    Okay, we'll give people a chance to respond. By the way, it's not uncommon that there is zero. Right. I've seen it we've we've done whole webinars where it's just because it's so hard to do when you need to do it. Well, somebody did 10, externally. So you're already already beating.


    Nestor Carrillo 52:00

    It curious if any of the answers are especially the 10 Plus response? Is that a monthly or you can give more context to what that looks like? That'll be interesting.


    Jerrod Bailey 52:11

    By the way, Nestor, I don't see the option of zero on here. So it's very possible that people don't have the answer that they they can't give the answer that that they want to hear.


    Nestor Carrillo 52:22

    That's a good question. That's a good point. Yeah, if the answer is zero, feel free to drop that in the chat as well.


    Jerrod Bailey 52:29

    Because that is the most common answer. Just so everybody knows. He'd sit in case you guys are wondering, are you? Are you an oddball? or anything like that? Because you haven't done these externally? You're absolutely not. Yet, Kara, one to two. Good. Got another answer? Five to 10. So good, good to hear that this is being done. Well, I think with that gang, I think this is hopefully this has been a productive hour. If nothing else, hopefully gives you some inspiration as far as what you might want to take back to your your leadership or your medical committee. But if you ever have any questions, you can certainly reach out to Medplace, you'll get our contact information afterwards. And, of course, everyone here might have a relationship with constellation, you can always ask any of your, your contacts over there. But I do hope that you enjoyed this. If you ever want to try this out. It's very, very easy. You can just review and through our platform, and we can show you how to do it and have humans help you along the way. But I hope that everyone does keep leveling up as far as your delivery of care and quality. And Terri, just want to thank you. It's always good to I didn't get to see your face, but it's good to talk to you.


    Terri Schimmer 53:45

    No, absolutely. Great program.


    Jerrod Bailey 53:48

    Appreciate you being such a great partner and everything that you that you've done at Cherokee. And now I think everyone didn't catch this. You just recently retired as of July. So now you're taking care of grandkids and enjoying life.



    Yeah, yep. slowed down a little bit. So good to see. Good to see. Thanks.


    Jerrod Bailey 54:08

    All right. Well, thanks, everybody, and look forward to meeting everyone over time.


    Jerrod Bailey  06:28

    Thanks, Nestor, that was great. So I'm not going to be doing a lot of the talking today, I am going to kind of pipe in some, some ideas as we as we discussed, but you know, my technology is about or my background is in technology. So really, my angle is to figure out what a law firms do well, what are your superpowers? And what would happen if you were able to front end and infuse into what you do well, with technology, so as part of our approach for what we do at my place, and you can see, we've got staff that come directly out of law firms. And so the goal is to really say what, what is the next version of an expert witness sourcing and preparation things? What does that look like? What does 2.0 look like? And what is our role in that? What is what are your your roles in that? How can we build it together. So today's going to be specifically unpacking how to prepare doctors for roles, like consultants for case reviews, and then for medical legal work, like expert witness work. So we'll get into like, just the standard process today. And then new approaches, and Adrienne fu che is going to go into that, again, she's the VP of cleanups here. And she's really responsible for sort of designing with us how we do that, and also taking an input from the law firms that we work with. And then we're going to talk about how to prepare for expert witness testimony. And this is really going to be where any handgun comes in. And really kind of unpack best practices there. And then maybe some new ideas that you haven't considered some new things that you might want to be looking at. And then we're going to open up, just have a panel discussion and talk about this together. I want everyone who's listening, if you have questions along the way, or ideas that you want us to explore, just pop them into the chat. And we'll handle them there. So now, so I'll just this is my only slide if you think I'm really going to talk to you. But why does this matter? Why do we Why do you care about preparing doctors will one, the best reviewers, the best witnesses are professional doctors, right? They're not professional witnesses, many of you have been in the situation where you know you're in, you're in trial and cross examination is happening from either side, and you have a professional medical witness can be really great. But if you have a really great doctor that has been prepared well, to sit in that seat, oftentimes that's what we're looking for, right? These are really practicing clinicians, they have the most up to date insights. And that's what we want to cultivate. But how do you do that at scale? Right? How do you find these doctors at scale and prepare them for this type of work? And how do you get these individuals prepared for a what is essentially a non clinical experience? Right, they're used to talking within a clinical environment, how do you prepare them for something that is more of this legal process? And you know, ultimately handle the third bullet point or did they convey to a jury that their perspective in a compelling way that's going to help not only you win the case, but you know, really help the jury understand the issues, these really complex issues that a layperson needs to be able to understand so he's going to walk us through some of that strategy as well. So with that, think our next slide Oh, I'll give a little bit on the old way versus the new way, right? So the old way, many of us are still doing this, right? With a Rolodex of doctors. And we know we're overusing some of our doctors. But we can rely on that. And we've done it for years. But  can we start to stretch outside of that, right? A lot of us are going to Google to find doctors, we're looking at expert directories, right. So we're finding that in places that you know, there are professional medical experts, and they may not be the place that we want to be looking. So the new way, the way that we adhere to the way that we really try to enable is really vetting these professionals, with  professionals understand the medical and legal industries, right, and doing that at scale, talking to 1000s of doctors instead of 10, or 20, or even 100 and filtering down to the ones that that are really usable in these types of contexts. And using technology to front end the process. How do we take a great paralegal or a great Associate Attorney and plug them into technology that lets them augment what they do what they do well, but do it at scale, being able to streamline things like searching and scheduling and contracting with doctors and make it so that more doctors want to respond to you when you outreach because of the experience that you can give them? And then ultimately training experts in a way that law firms will find the insights most helpful, right? So how do you prepare them along this journey, from case review to expert witness work to trial work that really sets them up for success. So that's what we're going to try to unpack for you guys today. That sounds good. With that, I think our next slide is actually me handing it off. So yeah, now I'm going to give it over to Adrian to talk about just the kind of the front end of the process, right, preparing for case reviews.


    Adrianne Fugett  11:56

    Great. Thanks, Darren. Good morning, everybody, or afternoon, if you happen to be on the East Coast. I'm going to tag on and add to what our CEO has shared, I will share with you all before I started with Jared, I was pretty good at computers. But I was really excited to see what Jared was doing. And when I fully understood this process and how much easier and quicker and more efficient, we could make these case reviews. You know, I was pretty excited to hear about it. So it's been a lot of fun and a really a true honor to work with Jared and his expertise and create this product. But I'm going to walk through obviously, many of these points are very familiar to all of you. And these are things that you likely do yourself or you expect your nurse paralegal to do. So I'm going to walk through and compare and contrast and just tell you what you know we do here at Medplace when we are matching a case to an expert for you. So one of the things that's really important to me, before I match any expert, which I'm sure you all can relate to is obviously you know, knowing the criteria, especially when we need to find an expert that is not already in our database, or our Rolodex as Jared was sharing, this is somebody that we need to, we either need to go to a Peer, peer reviewed article and search the bibliography, we've just got a really big feat ahead of us. So obviously, one of the most important things I look for here at Medplace when somebody sends a case to us is I want to know the criteria. I want to know the facts. I want to know the dates of service, I want to know the expert type, I really want to understand what we're looking at because that is something that before I even match you to an expert will help me make sure that we get the right expert. And that's what we do when we interview people as well. We find out with all of our experts. And I'll get a little bit more into that as I move in through this slide. But we really want to know what their specialties are. What do they do any extra procedures that are new and might be interesting. So that's really important for us at med plays. We want to know what what the case facts are in your case. We also before we interview anybody, myself and my team, we will check the backgrounds of any potential nurse or physician that comes to us for an interview. We will check their licensing to make sure that their license is in good standing and there are no actions against their license and we will do that before we even ask them for an interview. When we do interview them, we will ask them if they have any current or pending judgments against them. Usually I'm looking at $50,000 or more within the last 10 years. And as you guys know, that's not always easy to find. And it doesn't always mean that they're not a good expert sometimes physicians find themselves, just, they're on the long list of whoever signed the chart for a case. And so we do like to get that information upfront. And we also ask them if they've done any expert testifying work before. So we do a really thorough vetting, actually, once we get them on the call. We vet them for communication and their dispositions. So we do probably 70% or more of our interviews, all via zoom. As you guys know, it can be a real challenge, sometimes getting a physician or even a nurse on the phone. But we really do encourage that before we even have them interview for our platform, what we look for on a zoom call is their disposition, how will they communicate? Would they make a good testifying expert? Are they interested in testifying Why or why not a lot of times, as you guys know, you find that there could be an excellent expert that you come across and Amy, we'll get more into this, but they've got all of the great information, they're supportive of your care, but they're not necessarily going to make a good testifying expert. So we work really hard with our experts, as we're interviewing them and training them and, and getting them ready to even be on our platform, we go over the standard of care, making sure they understand that, when you look at these cases, and when you work with attorneys, really be thinking about the standard of care in this particular patients in physicians setting. So were they in a level one trauma center, or were they not what kind of access to resources did they have, because what we don't want to do is I know myself as a nurse, and I know working in a trauma center that sometimes you would find yourself practicing above and beyond the standard of care, because you're you're afraid of lawsuits. And when you do that you kind of raise the bar, you raise the standard of care, not knowingly or not intentionally, I should say. So we want to make sure when we're talking to experts that they really understand the setting, and that they're really empathetic and compassionate to everybody involved, so that they can really speak to the standard of care, and that we also explain to them causation. So we do a pretty thorough interview process before they even get on boarded. And then we have denied experts before for obviously a myriad of reasons that they have actions, or they're not in good standing with their license, or they've had multiple lawsuits at a high dollar value, of course, they won't even make it to the interview. And then if they're if they don't perform well in their zoom interview, so that's something that when I was working in the law firms that I didn't always have time to do when I you know, when I found the expert that I wanted by going through the bibliography and reaching out and getting a hold of set expert being really excited about it, I didn't always have the time to do all of these vetting. So it's, it's pretty, it's a good feeling that the experts that I know we've got on our platform who have gone through this fairly thorough, rigorous process. And then our experts here at Medplace, we do give them a document that I created, it's pretty straightforward. It's something any of us can do. It's just things to understand what attorneys are looking for what claims consultants with insurance companies, what are they looking for, when you get on a call, or when you talk to them about a case really guiding them especially because as Jared said, our experts are not professional experts. They're professional physicians right there. They come to Medplace because they're excited about this line of work and they want to learn about it. So we do give them a document as well after the interview that kind of gives them some pointers to keep in keep in mind as they're chatting through these case reviews. We also have videos where we have done kind of a inside view of what it looks like on a claims call. So that's something that we share with our experts so they can see an expert being on a call with a claims consultant and kind of how to guide that call so they understand what comes across. Another thing I will throw in here too. That's also really helpful at the top point there knowing your criteria, the questions that you as well as your case description, but questions that you have Have for your expert are also really helpful for me when you load a case onto our platform. And that's also helpful for the expert, right? Because you don't want them going through 1000s and 1000s of pages, that will be very expensive to you. So that's kind of something as we talk about best practices that we really want them to be able to focus on what are the relevant points of this case? And exposing vulnerabilities we tell our experts that be prepared and understand that, what will the plaintiff be looking at as a vulnerability in this case? And why and why is it not really a vulnerability or is it and steer away from it, and Amy, we'll get into that as well. And then I also explained to our physicians and nurses to really be able to give you this information in a format that's digestible for a jury. And for a layperson, we really encourage them to understand that when they're talking to attorneys, and when they're talking to claims consultants that, although they're all really very well seasoned in what they do, they might not always know all of the lingo in the medical terms. And so we really do encourage them to make sure that they're using that opportunity as they're doing these first initial reviews to be really clear, and really careful that they're explaining what is happening, what happened in this case, what the outcomes were, and do it in a way that's digestible to a jury and to a layperson. And so I've got one more slide and then I'm going to turn it over to Amy. So next slide Nestor. So, I've kind of hit on some of these points a little bit. But one of the really cool things, like I said, when I got to work with Jared, and we created this platform is I get case requests every day. And it can be for any myriad of experts, pediatric neurosurgeon, and that was always interesting, that was not an easy, easy find, as you guys can imagine. But what we do here at Medplace is we allow you to not overuse the same experts. And we will give you that turnaround to pick from about three experts within 24 hours or less. And again, we talked about how you don't necessarily have to go through the bibliography yourself. We've done that here at Med play, so you don't have those cold resort outreaches, to find experts. And then again, that fast matching, that's something that you know, working in a busy law firm, when I was in Texas in Louisiana, that having three or more well vetted experts to pick from in less than 24 hours was pretty, pretty exciting. And then the other thing, getting records to your clients. So with our platform, what's really unique about this is you cut down on a lot of time with the paralegals in your law firm. And you know, they can be doing other duties that you need them to do. So on our platform, they are experts, they access the records right from the platform, they're not able to download them that protects HIPAA that protects you that protects your client. So they have complete access to everything they need, including imaging on their platform. Also here at Medplace, let's say you've got 10,000 pages of records. And you don't necessarily want to spend the time because you've got to get this reviewed quickly. You don't want to spend all the time, you know going through those records. As I mentioned in the first slide, as long as we have a good description the case description, what type of expert you're looking for, and the questions for the expert, our team can narrow 10,000 pages down to about 650 pages of relevant records tabbed and organized in a PDF that can allow the expert to focus on what you need them to focus on, especially on that first view that first look like what's going on in this case, are there damages are there not damages, so you're not sending secure links to drop boxes, you're not having to prepare paper records, some experts that I've worked with still want paper records and giant binders and, and you're worried about sending them to their home and you know if someone's going to come steal this box thinking score, it's a it's a great precedent and it really ends up being you know, a giant box of HIPAA violation. So that is something that's really unique about our platform, and I do oversee that. I do have a team that does that and organizes that and that is overseen by me. I organize those records Here's how I was taught by attorneys in the law firms that I worked in the schooling that I had. So it's, it's pretty exciting. And then again, like I said, the record ordering and organization. And so now you've got this really robust way of getting experts that you need really quickly, especially if you're in a crunch, and you get your review. And let's say that you really like this expert that you're doing the review with, and you want to hire them. So the next step is getting them properly prepared to be able to be a testifying expert. What I shared with you that little bit that I do, that's a little tiny snapshot in time, right? But it doesn't, it's not really enough to make sure that they're going to be a good testifying expert. So that's where Amy comes in. And she can talk about what she does. And she's gotten a huge assignment of really teaching all of us what's really valuable about teaching experts remembering to not come across arrogant, right? Because they have all of this knowledge and information and how can they present that in a way that that doesn't come across as putting off the jury. And using good visuals, because all of us even this slide presentation, it's much better and easier to talk about our points if we've got really good visuals. And so I'm really excited to turn it over to Amy and Amy.


    Amy Hanegan  26:30

    Thank you, Adrian. Good morning, everyone, or good afternoon on the East Coast. I'm going to focus on two things today. First of all, what do jurors expect of expert witnesses. And I have worked with numerous experts over the years in preparing them to testify effectively. And I hope to provide you with some tools that you can use immediately when working with the experts things that you may not have done in the past. And I'd certainly like him when we start to have our panel discussion to hear your ideas. So what did yours expect? Well, first of all, when you say the word expert jurors expect that they expect that the expert witness will be the best in his or her field, they are expecting that they will be able to explain the subject matter so they can understand it that is a given. And they really want to make sure that for them for a juror to do his or her job, that they are addressing the allegations in the case directly. And they like to hear the support to support and defend their position with facts not going off into the weeds, but really supporting what they feel happened. What happened, how it happened, what should have happened if it didn't happen. And they are hoping that the expert will be an excellent teacher because they realize that they aren't medical experts. All they have is their experience their own medical experiences, working with doctors going to the doctor going to the hospital being in an emergency room, being diagnosed, having relatives that were diagnosed, and so they really need the expert to be an excellent teacher. And that's something you want to start looking for immediately. When you are working with your experts. They're really hoping that the expert will provide them with the information they need to make an informed decision that they will have information when they are deliberating that they can use that they can actually repeat during deliberations. And they also want to see someone they want to see an expert witness who can really relate to them as patients or their loved ones. Not being professorial, I guess is the easiest way to say it. Can I have the next slide Nestor? Nestor Can I have There we go. Thank you. Yeah, next slide. Great. So I think we really want to remember a couple things here that when you're choosing an expert, what is the case require? Is this going to be a battle of the experts you know, very commonly, we realized quite quickly that this is not going to really be about The defendant, this case is going to be a battle of the experts. And that is something that you should be determining. And I'm sure you are early in your evaluation of the case. There may be devastating outcome, but was the standard of care appropriate. And this is what we'll want to make sure that the expert is willing is ready to address. We talked to Adrian, talk to you about the common vetting processes that met place uses. And really getting back to what do you need from this experts? So can we go to the Can we go to the next slide, please? All right. Now, one of the things that I have found this very helpful, is it certainly during my witness preparation sessions with experts is I find that there's a lot they want to tell the jury. But what you need to focus his focus on pardon me, is what they need to tell the jury. Are they clear on the allegations that they are addressing? It's amazing to me how they can just go off and onto tangents. And I'm like, Whoa, how does that relate to the allegation, and when you keep bringing them back to what the allegation is that they're addressing, it's very helpful to them. And it keeps them in what I like a concept that I use with all my witnesses, whether they're defendants or experts, is what is their piece of the pie. So sometimes expert witnesses feel that they have a much bigger piece of the pie than they do. And it's your job as attorneys and even claim representatives, that they are clear as to what they are being hired for and what they're not being hired for. And this will help streamline and create effective testimony, once they understand what their piece of the pie is, and the allegations to which they are referring. Next slide, please. All right. So when we get into specifics of working with experts, I find that the one thing that I need to hear over and over are the development of themes, or what we'll call reiterative statements that the jury can repeat. And sometimes I have actually pulled out or asked the attorney, not me, but I've asked the attorneys to pull out the verdict form. And let's look at the verdict form and which questions are they addressing? They may not be addressing liability, but only causation. And if that's the case, then we need to get them focused more on that. And what I really find important is to make sure that they are creating themes with you with your help, that the jurors can repeat that they can quote those experts I give you on the within the purple box here I've created two examples. There was no delay in Mr Jones's cancer diagnosis. If that should it be a failure to diagnose? Or something a little more complicated. The placental pathology proves that the baby was damaged three months before birth. Some of you may know Rebecca Barragan. I worked on a case with her as an expert. She is the placental pathology expert. And we just had to get her to be able to definitively say this, though her slides were illustrative we had to work on getting them so a jury could understand them. Can we go to the next slide, please? Okay, now, I am an huge proponent of the expert witness working directly with a visual strategist. I work personally with Diane Meyer of legal presentations. I'm happy to provide her information to you. And what I have found is that a lot of and you've seen this too, a lot of experts think that if they just use the medical chart, or they have some kind of visuals that they've prepared that they will be effective for a jury. Sometimes they have prepared those visuals for their peers. A jury isn't going to understand those. So I think it's absolutely critically important. I cannot stress this enough that your expert will and you work with A visual strategist, someone who really knows medical malpractice and knows how to create graphics that will help really allow the jury to understand what is happening. Visuals should be simple and persuasive. At the same time, it should be absolutely clear what we're trying to show, if they're in terms of timelines, how things were happening over time. Rather than showing pages and pages and pages of medical records a visual strategist can help you create a timeline that will be very illustrative of what you need. And not only should the visuals be used, they should be used throughout an expert's testimony, both text and graphically, but you'll want to be using those same graphics within with throughout the whole trial so that the jury is seeing things repetitively. Next slide, please. Okay, so here are some tips that help expert witnesses do a much more effective job when they're testifying. First of all, you need to make sure you let the experts know who ended up on the jury. They may be thinking they have a much higher level of education than is actually than those who actually have appearing cut for jury duty. And certainly, something that I find is often left out, is to make sure the expert witness knows what is the jury heard so far? What are you What are you feeling the jury is getting and what do you need, the expert to make sure is emphasized during his or her testimony. And I find in continuing with this, that they need to be using terms like what is most important, what we need to focus on here, actually having the jury hear those words now in some venues. And I'm not sure in your venue but in venues elsewhere, jurors are allowed to take notes. So when an expert witness says what is most important, that really helps in terms of the jury writing that down and taking that into deliberations. Also, you would be emphasizing that throughout your opening statement, your closing argument and with the your defendant. Also, there is no substitute for practicing direct and cross even with an expert. You know, just because an expert witness pardon me, just because an expert witness has a tremendous resume, and has a phenomenal set of accolades after their name, that does not make them a good witness that there is no substitute for you actually practicing direct and cross examination. And you need to set up those  times with them when you will be reviewing that and preparing them for what they can expect to hear on cross examination. Especially when if you're working with newer experts, who are very well trained, very well vetted, certainly bioMedplace or else and they really want to do a good job. So you got to help them do a good job. And the best way to help them do a good job is to review their testimony with them not talking about it. Please don't interpret, practicing direct and cross as talking about it, you need to hear them actually testifying in a practice session. Now for you, I just want to make sure that you understand that repetition is the best tool in the courtroom. You can repeat themes that that you have created for your expert witnesses throughout the trial. The jury should be hearing these in opening statement it throughout testimony and certainly in closing. And I will say that most experts really do want to do a good job but they are so easily find themselves in the weeds and the jury gets bored and they are they're not following. They talk they tune out. And what we want to do is keep them tuned in by having effective dynamic testimony. Now I didn't get into all the today all the delivery aspects that need to be addressed. And certainly, I'd be happy to do that with you. But these are the some general ideas of working with experts. And I hope that is helpful. And we're going to open this up to certainly open it up to questions.


    Nestor Carrillo  40:22

    Thanks, enemy. We have some questions here, ready for the panel. But again, if you have any questions, feel free to drop them in the chat. And we'll start working through those. All right. First up, so this could go for either Adrian or for Amy. What are some of the most important qualifications when you're interviewing a doctor or nurse for either review, or expert witness testimony work?


    Amy Hanegan  40:58

    Well, Adrian, Adrian should approach that first. Yeah,


    Adrianne Fugett  41:01

    I mean, I probably have some and then Amy, you probably have some stuff to add. So some of the most important things we look for is your years of experience we want to make sure that you've got for nurses, at least five years, as you guys know, the burnout rate for nurses is seeming to be a little bit quicker nowadays. But for physicians, we look for physicians that are board certified, and that have been practicing in their area of expertise for 10 years. And then of course, some of the other items that I covered in my presentation about any judgments is their license in good standing, that sort of thing. So those are things that I look for whether I'm working in a law firm, or here at Medplace, and then Amy, I'm sure you take that even a step beyond what you're looking for what you're trying to develop within a potential expert.


    Amy Hanegan  41:55

    Well, I'm going to get the expert when they're already hired, and they're on board and they're ready to testify. And so I'm looking for their communication skills, how effectively they are communicating themes. And very often I just have to get them focused on themes. But what happens first is usually I look at the visuals that have been prepared. And I'll say, Ooh, we need to get you something that will support you more effectively when you're testifying, because what you're trying to say is not clearly visualized. You know, one of the things I want to tell everybody is that the research shows that people spend more than 11 hours in front of a screen, the average number of hours spent per person. So people expect visuals, they expect to see really dynamic visuals. And if the expert does not have those, you're really taking a chance that the jury will not be getting what they need to make the decision in your favor. Yeah. Yeah, I mean, we're


    Jerrod Bailey  43:04

    any litigants on this call know that they're there. There's essentially storytellers right through their founding their story of data on persuasive arguments, but they're creating an arc for the jury to follow. And, and visuals are just a just such a core part of storytelling. It's, it's really great. I love that you incorporate those in.


    Nestor Carrillo  43:28

    Okay. Here's another question. How important is ongoing training for reviewers and expert witnesses? And why is it important? I think Amy,


    Adrianne Fugett  43:45

    I mean, that's kind of what you do as you're getting the expert ready, right, constantly reinforcing what, what they know how they're going to present it?


    Amy Hanegan  43:55

    Yeah. The first thing comes to mind is that each case is different. And may though they may have testified in the past, the case that they're, you're asking them to testify about their role may be slightly different. They may need a refresher on reminding them about the jurors. We are gearing things to a seventh grader jurist, here's a little trick jurors don't mind hearing what they already know. It makes them feel smart. So we get it, you know that they have to bring it back down. They're not talking to their colleagues. I'm not sure that actually dresses the actual question. I'm not sure I'm sure. But in terms of practicing and reviewing every time they testify, if you're hiring them, if you're working, you need to have a practice session with them for sure. Yeah, that's great.


    Nestor Carrillo  44:51

    Another question here. Why should law firms consider a new approach for these reviews and expert witness testimony we talked to up to standard approach, why should they consider the new approach?


    Adrianne Fugett  45:04

    Yeah, I mean, both Jared. And I probably can speak to that Jared. Right. I mean, I think what Jared and I have seen here at Medplace. And what we've heard from our clients is, the turnaround time for getting an expert and getting a case reviewed, depending on your schedule, as the attorney can be as quick as three days or three weeks, and you've got the completed review done. And that's, and then again, as both Jared and I touched on, you're not reusing the same expert. So you're not creating kind of a built in bias, by using your same experts that have served you well, but you're exploring your options. I don't know what else you probably have more to add to that, Jared.


    Jerrod Bailey  45:44

    Yeah, I wonder I wasn't planning on doing this. But I wanted to show you something I wanted to show you the kind of experience we create for doctors and just kind of let you let some of you imagine, what if we were providing this experience to our doctors? Do you think I could do that really quick, you guys, he goes up for an impromptu, visual. So Netflix has a platform like Uber, where our doctors are essentially our drivers, right? But imagine if you, you can use our platform for your own experts. And as you're doing your own recruiting, imagine you went to an expert and said because remember what's happening with them, you go to somebody who's a practicing physician. And if you've ever heard this, like, you know what, I did a case for somebody before, and it was really clunky. And it took me six months to get paid on it. And, and they sent me a banker's box of documents. And you know, I'm busy, I'm in the clinic, I'm practicing surgery every day. For us, we go to a doctor and say, hey, look, we'll create a login for you, it will take about 10 minutes to fill in, fill out your onboarding paperwork, which is their top tax documents how they want to get paid. And then we give them this dashboard, where they get to see what you know what they've done on the platform they get, they've just got a new request, it's can be across that's coming from you, gives them some basics on it's got some medical records, shows them what they're going to earn, they can just accept it, they get a ping right on their phone. So you have a lot more access to these doctors. And then once they have it open, look, I'm looking at the tabbed organized record and I can peruse all of this in my browser, I can look at all of my imaging files, I can chat with you and ask you questions, I can send you my availability for the deposition or for the case review that we're going to do. It's just really, really simple. And that's why we're able to we have such a high conversion rate with doctors practicing physicians, because we use technology designed for them to make it really easy. So imagine your offer is you're going out and finding more doctors and leveraging our platform to find even more, imagine that you have this kind of technology front end to your process, it's a really big differentiator in your conversion rate of being successful, of getting those experts to actually agree to do work with you is it's way different than what you're probably used to. So hopefully that gives you a little bit of illustration around that. But if you don't, whether you use Medplace or not like figure out how to create a good experience for your doctors. And technology really is the amplifier for that. So whether using Box and Ambra, and all these other tools and zoom, figure out how you're going to use those and integrate those into a really seamless experience because you'll find your conversion rate to actually be successful with doctors, getting them more willing and onboard to continue work for you again, it's just very, very high. That's great. Thank you, Jared.


    Nestor Carrillo  48:41

    Here's a question that can go to both Adrian and Amy. How do you tell an expert they need to work on either their review or their presentation for expert witness testimony? It's a difficult conversation. How do you approach that?


    Amy Hanegan  49:03

    In you want to go for okay, I'm happy to address that. So this can be difficult, where you are very impressed with your witness you like you like all the papers they've written you like that they are just so well renowned. And you really think they're going to be great. And then the more you talk to them, you're a little concerned that their testimony is going to not is really not going to fly. Now we've been talking, I've been talking I should say in this webinar about preparing people for trial. We're in front of jurors, but then of course there's the preparation for deposition. And that's where you can really start making headway. Really start working on those themes. I mean, you want to make sure that that expert is relaying the information you need to that is very persuasive to the opposing counsel. And in doing so, you can take that opportunity to review that testimony. And just work as a team just take a team approach, that you're working as a team, you want to make sure that you're hearing the answers that the expert witness will be providing in a deposition or trial, you want to hear them and you want to make sure that they are aligned with your entire approach to the case. So I think it's right it starts right from the beginning, as soon as you start talking about preparing for deposition. And you can say, I'm going to want a practice session, I want to review and do a mock deposition with them, making sure that they hear the questions that you feel are most of called and will most likely be asked of them. Because you don't want to pick up their deposition. You don't want to get into that deposition. And you're hearing paragraph after paragraph of an answer when you need it to hear a definitive and decisive statement. And teaching them the ins and outs of waiting for opposing counsel to ask the follow up question. If they don't ask they don't get.


    Nestor Carrillo  51:26

    That's what I would say. That's great. Another question. Again, I think, either to Adrian or Amy, can you share an experience where an expert either failed to meet or exceeded expectations? Question?


    Adrianne Fugett  51:43

    Yeah, that's a good question. I think Amy, probably you have a lot more stories in that arena. So go for it.


    Amy Hanegan  51:51

    Oh, dear. Well, one thing I know they really one thing they really like jurors really liked to hear. And I remember this is I always have an attorney include a question as to why did you become a placental pathologist? Why did you become a cardiac surgeon? Why did you become they just love jurors just love to hear the background. And we had a situation, very difficult case, very sad, very bad damages damaged. up, baby. And this O V, was the expert was so compassionate, and talked about how even in medical school when he would see started to see babies who were damaged, he talked about how that affected him. And how he knew. As soon as he put his hand, I remember him saying this. As soon as he put his hand on that damaged child, he knew he had to help. It was moving, I can tell you so that personal experience is so critically important with an expert, don't let them just I know, we're very focused on the allegations, as I have said, but we can't forget that these doctors, these experts must relate to those who are listening to them. Now, that's not going to come through in deposition. Understand that, obviously, but once you get them in front of a jury, and you're preparing, make sure that you're asking them for a personal experience as to why they chose the field that they're in and include that in the direct exam.


    Nestor Carrillo  53:40

    Yeah. Fantastic. Last, last point, Jared and Amy out first with Jared, I think we can wrap on this What's How can law firms or any organization partner with that place? Amy, same question to you after Jared, how can law firms partner with better witnesses, even in combination with that place.


    Jerrod Bailey  54:07

    So I'll start so my place is really easy to work with. If you've got a case you've got a specialist you're looking for, you can literally get a logon created for free in a day and you can be looking at CVS by the next morning. You really only pay for anything once you finally commit to the doctor that you pick. And we are nationwide we service all 50 states we've got hundreds of physicians around the country of every specialty you've ever heard of even hard to find ones and we do have a pretty effective recruiting engine whenever there's one that we don't already have. So that's fairly easy to work with. Now you can also work this programmatically, you can like being able to do lots of things all year long.

How can hospital systems avoid bias in their peer review process? How can healthcare administrators streamline the review process while still showing empathy for patients and providers? In this presentation, Terri Schimmer and Jerrod Bailey explain how health systems can leverage Medplace for better peer review by discussing a real-world example; Cherokee Regional Medical Center.
Terri Schimmer (circle)

Guest - Terri Schimmer

Former Risk Leader at Cherokee Regional Medical Center

Terri Schimmer is an experienced RN that has worked at a critical access hospital in Cherokee, Iowa for the entirity of her career. She most recently worked as a patient advocate and risk manager after initially overseeing peer review.

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